Delaying haematopoietic stem cell transplantation in children with viral respiratory infections reduces transplant-related mortality.

Autor: Ottaviano G; Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.; Department of Paediatrics, University of Milano-Bicocca, San Gerardo Hospital/Fondazione MBBM, Monza, Italy., Lucchini G; Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK., Breuer J; Department of Microbiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.; Division of Infection and Immunity, University College London, London, UK., Furtado-Silva JM; Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK., Lazareva A; Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK., Ciocarlie O; Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK., Elfeky R; Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK., Rao K; Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK., Amrolia PJ; Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK., Veys P; Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK., Chiesa R; Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
Jazyk: angličtina
Zdroj: British journal of haematology [Br J Haematol] 2020 Feb; Vol. 188 (4), pp. 560-569. Date of Electronic Publication: 2019 Sep 30.
DOI: 10.1111/bjh.16216
Abstrakt: Viral respiratory infections (VRIs) contribute to the morbidity and transplant-related mortality (TRM) after allogeneic haematopoietic stem cell transplantation (HSCT) and strategies to prevent and treat VRIs are warranted. We monitored VRIs before and after transplant in children undergoing allogeneic HSCT with nasopharyngeal aspirates (NPA) and assessed the impact on clinical outcome. Between 2007 and 2017, 585 children underwent 620 allogeneic HSCT procedures. Out of 75 patients with a positive NPA screen (12%), transplant was delayed in 25 cases (33%), while 53 children started conditioning with a VRI. Patients undergoing HSCT with a positive NPA screen had a significantly lower overall survival (54% vs. 79%) and increased TRM (26% vs. 7%) compared to patients with a negative NPA. Patients with a positive NPA who delayed transplant and cleared the virus before conditioning had improved overall survival (90%) and lower TRM (5%). Pre-HSCT positive NPA was the only significant risk factor for progression to a lower respiratory tract infection and was a major risk factor for TRM. Transplant delay, whenever feasible, in case of a positive NPA screen for VRIs can positively impact on survival of children undergoing HSCT.
(© 2019 British Society for Haematology and John Wiley & Sons Ltd.)
Databáze: MEDLINE
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